Lung aspergilloma with pituitary invasive aspergillosis presenting as headache and hyponatraemia

2021 ◽  
Vol 14 (1) ◽  
pp. e238721
Author(s):  
Eunho Choi ◽  
Sun Bean Kim ◽  
Jong Hun Kim ◽  
Young Kyung Yoon
Keyword(s):  
Diabetes Mellitus ◽  
Differential Diagnosis ◽  
Mortality Rate ◽  
Invasive Aspergillosis ◽  
Fungal Infections ◽  
Imaging Study ◽  
Lung Mass ◽  
Tissue Invasion ◽  
Life Threatening ◽  
The Brain

Fungal infections involving the pituitary gland are rare and can be life threatening. A 75-year-old man with hypertension and diabetes mellitus presented with headache and hyponatraemia. Imaging study showed right upper lung mass, and mass resection showed aspergilloma without tissue invasion on histology. The patient developed visual impairment a few weeks later, and MRI of the brain revealed bilateral sphenoid sinusitis and pituitary invasion. The trans-sphenoidal biopsy confirmed invasive Aspergillus infection. His sphenoidal sinuses were endoscopically debrided, and he was treated with oral voriconazole. Pituitary aspergillosis should be considered in the differential diagnosis in patients with lung aspergilloma with headache and sinusitis. Prompt biopsy and antifungal treatment are important due to the high mortality rate of the infection.

Systemic Diseases Associated with Nasal Symptoms

1987 ◽  
Vol 1 (1) ◽  
pp. 33-44 ◽  
Author(s):  
Guy A. Settipane
Keyword(s):  
Differential Diagnosis ◽  
Fungal Infections ◽  
Systemic Disease ◽  
Systemic Diseases ◽  
Proper Treatment ◽  
Csf Rhinorrhea ◽  
Nasal Symptoms ◽  
Appropriate Treatment ◽  
Life Threatening ◽  
Careful History

Many systemic diseases are associated with nasal symptoms, Rhinitis associated with asthma is probably the most common with leprosy and fungal infections being the rarest. A careful history and nasal examination in a patient with rhinitis may lead to the discovery of more significant systemic diseases. Proper treatment of systemic disease will often cure or improve the associated rhinitis. Similarly, appropriate treatment of the rhinitis/sinusitis may reduce systemic complaints such as asthma. At times, identification of the cause of rhinitis as in CSF rhinorrhea, Wegeners’ syndrome, etc., alerts one to a life-threatening entity. Thus, it is apparent that the nose is an excellent mirror of some systemic diseases and identifying and understanding the differential diagnosis of nasal symptoms may be a tremendous help in diagnosing the disease and treating the whole patient.

Benefit of Endoscopic Surgery in the Management of Acute Invasive Skull Base Fungal Rhinosinusitis

2020 ◽  
Vol 82 (S 03) ◽  
pp. e330-e334
Author(s):  
Megan R. D'Andrea ◽  
Corey M. Gill ◽  
Melissa Umphlett ◽  
Satish Govindaraj ◽  
Anthony Del Signore ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Mortality Rate ◽  
Skull Base ◽  
Fungal Infections ◽  
Hematologic Malignancy ◽  
Nasal Congestion ◽  
Postoperative Mortality ◽  
Surgical Interventions ◽  
Presenting Symptoms ◽  
Fungal Rhinosinusitis

Abstract Objective This article aims to characterize 14 patients who underwent purely endoscopic surgical debridement of acute invasive skull base fungal rhinosinusitis, and to evaluate postoperative outcomes and risk for recurrence. Design Retrospective cohort study. Setting Tertiary single-institution neurosurgery department. Participants We performed a retrospective analysis of all patients with skull base fungal infections treated with a purely endoscopic surgical approach at Mount Sinai Hospital from 1998 to 2018. Main Outcome Measures Clinical presentation, number of recurrences, and mortality rate. Results The most common underlying medical comorbidities were hematologic malignancy in 8 (57.1%) patients and poorly controlled diabetes mellitus in 7 (50%) patients. Presenting symptoms included headache (50%), eye pain (35.7%), facial pain (28.6%), visual changes (21.4%), and nasal congestion (14.3%). The fungal organisms identified on culture were Aspergillus (42.9%), Mucorales (28.6%), Fusarium (14.3%), Penicillium (7.1%), and unspecified (7.1%). Eight (57.1%) patients developed recurrence and required multiple surgical debridements. Patients who had only a hematologic malignancy were more likely to require multiple surgical debridements compared with those who did not have a hematologic malignancy or those who had both hematologic malignancy and underlying diabetes mellitus (p = 0.03). The mortality rate from surgery was 42.9%. Conclusion Surgical endoscopic intervention is an option for definitive management of acute invasive skull base fungal rhinosinusitis; however, postoperative mortality and risk of recurrence requiring additional surgical interventions remains high. Patients with hematologic malignancy may be more susceptible to recurrent infection requiring multiple surgical debridements. We recommend early aggressive multimodal treatment. Multiple debridements may be warranted in most cases; close clinical surveillance is needed during neurosurgical intervention.

scholarly journals An Uncommon Feature of Chronic Granulomatous Disease in a Neonate

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Razieh Afrough ◽  
Sayyed Shahabeddin Mohseni ◽  
Setareh Sagheb
Keyword(s):  
Mortality Rate ◽  
Chronic Granulomatous Disease ◽  
High Mortality ◽  
Neonatal Period ◽  
Fungal Infections ◽  
Granuloma Formation ◽  
Granulomatous Disease ◽  
Life Threatening

Chronic Granulomatous Disease (CGD) represents recurrent life-threatening bacterial and fungal infections and granuloma formation with a high mortality rate. CGD’s sign and symptoms usually appear in infancy and children before the age of five; therefore, its presentation in neonatal period with some uncommon features may be easily overlooked. Here we describe a case of CGD in a 24-day-old boy, presenting with a diffuse purulent vesiculopustular rash and multiple osteomyelitis.

scholarly journals Tatalaksana Penurunan Kesadaran Pada Penderita Diabetes Mellitus

Medicinus ◽  
2018 ◽  
Vol 6 (1) ◽  
Author(s):  
Ian Huang
Keyword(s):  
Diabetes Mellitus ◽  
Mortality Rate ◽  
Lactic Acidosis ◽  
Diabetic Ketoacidosis ◽  
Complications Of Diabetes ◽  
Uremic Encephalopathy ◽  
Hyperosmolar Hyperglycemic State ◽  
Life Threatening

Hyperglycemic crisis (diabetic ketoacidosis or hyperosmolar hyperglycemic state), lactic acidosis, hypoglycemia, and uremic encephalopathy are life-threatening complications of diabetes mellitus (DM). Specific therapies of each condition are essential in reducing mortality rate of the complications.

scholarly journals Fungal Invasive Co-Infection Due to Aspergillus fumigatus and Rhizopus arrhizus: A Rhino-Orbital Presentation

2021 ◽  
Vol 7 (12) ◽  
pp. 1096
Author(s):  
Juan Pablo Ramírez-Hinojosa ◽  
Salvador Medrano-Ahumada ◽  
Roberto Arenas ◽  
Arturo Bravo-Escobar ◽  
Sara Paraguirre-Martínez ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Mortality Rate ◽  
Aspergillus Fumigatus ◽  
Liposomal Amphotericin ◽  
Poor Prognosis ◽  
Diabetes Mellitus Type 2 ◽  
Fungal Infections ◽  
Rhizopus Arrhizus ◽  
Immunocompromised Patients

Aspergillosis and mucormycosis are filamentous fungal infections occurring predominantly in immunocompromised patients. Fulminant process with rapid infiltration of the contiguous tissue is distinctive for both type of fungi. The rhinocerebral co-infection by Aspergillus and Mucorales is very rare and is usually associated in immunocompromised patients with a high mortality rate. This rare co-infection leads to difficulties in diagnosis, and therapeutic delays can result in a poor prognosis. Overall, the treatment of choice is surgical debridement and liposomal amphotericin B. This paper describes a combined aspergillosis and mucormycosis case in a diabetes mellitus type 2 patient with chronic ulcerations of the palatal and cheek. To our knowledge, this is the first report of an uncommon co-infection of Aspergillus fumigatus and Rhizopus arrhizus in a rhino-orbital presentation.

scholarly journals Concomitant Mucormycosis with Aspergillosis in Patients with Uncontrolled Diabetes Mellitus: A Case Series

2021 ◽  
Author(s):  
Arpana Singh ◽  
Aroop Mohanty ◽  
Shweta Jha ◽  
Pratima Gupta ◽  
Neelam Kaistha
Keyword(s):  
Diabetes Mellitus ◽  
Aspergillus Fumigatus ◽  
Clinical Condition ◽  
Fungal Infections ◽  
Case Series ◽  
The Body ◽  
Invasive Potential ◽  
Uncontrolled Diabetes ◽  
Life Threatening ◽  
Systemic Manifestations

Fungal infections are life threatening especially in presence of immunosuppression or uncontrolled diabetes mellitus mainly due to their invasive potential. Mucormycosis of the oculo-rhino-cerebral region is an opportunistic, aggressive, fatal and rapidly spreading infection caused by organisms belonging to Mucorales order and class Zygomycetes. The organisms associated are ubiquitous. Aspergillosis is a common clinical condition caused by the Aspergillus species, most often by Aspergillus fumigatus (A. fumigatus). Both fungi have a predilection for the immunosuppressive conditions, with uncontrolled diabetes and malignancy being the most common among them. Mucormycosis is caused by environmental spores which get access into the body through the lungs and cause various systemic manifestations like rhino-cerebral mucormycosis. Here, a case series of such concomitant infections of Aspergillus and Mucor spp from Rishikesh, Uttarakhand, India is reported.

scholarly journals A Rare Case of Primary Aortoduodenal Fistula

2020 ◽  
Vol 20 (2) ◽  
pp. 164-166
Author(s):  
Hyun Jin Bae ◽  
Byung-Wook Kim ◽  
Joon Sung Kim
Keyword(s):  
Differential Diagnosis ◽  
Mortality Rate ◽  
Blood Loss ◽  
Gastrointestinal Bleeding ◽  
Rare Case ◽  
Aortoduodenal Fistula ◽  
Gastrointestinal Blood Loss ◽  
Threatening Condition ◽  
Life Threatening

Aortoduodenal fistula is a rare but life-threatening condition that can cause gastrointestinal bleeding. Due to its rarity, it is often overlooked as a cause of gastrointestinal blood loss. Notably, the mortality rate of aortoduodenal fistula is nearly 100% in undiagnosed and untreated cases. We report a case of aortoduodenal fistula, which resulted in the patient’s death. This report highlights the importance of considering even extremely rare causes of gastrointestinal bleeding in the differential diagnosis in patients with such a presentation.

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